BROADBAND AGREEMENT FORM

Broadband Application & Agreement Form v1/9/20
Account Name*
Contact Name*

First NameLast Name
Customer No*
CNXXXX
Phone Number*

Country CodePhone Number
USERNAME*
4 to 8 alphanumeric character case sensitive all lowercase
PASSWORD*
8 to 9 alphanumeric character case sensitive all lowercase
We recommend you change your password and wireless password on a regular basis.
NOTIFICATION EMAIL ADDRESS
example@example.com
STATIC IP ADDRESS
STATIC IP ADDRESS

Tick if required Registration Fee: $50 + Monthly $50
STATIC IP ADDRESS
BROADBAND PLAN
Select PLAN as per table. Please note your plan will default to NO EXCESS plan. No Excess capped at the data allowance as per selected plan. Once data cap is reached your speed will drop to 64kb/s and you will not be charged for any excess. Add-Ons are available to purchase once your cap has been reached. Please note you will be charged the FULL month's rental of your selected plan when your service has been connected and activated. This also entitles you to the full volume allowance per your selected plan. On your first billing statement, you will see a charge for the current month plan AND the following month's plan. Vodafone Cook Islands charges rental one month in advance.
Term of Contract - Fixed for 12 months (minimum)
Registration Fee:$75.00
FROM:
TO:
Modem Selection*

Vodafone Supply Modem: $189.00Customer Own Modem

SELECT PLAN*

	NO EXCESS
STANDARD
VALUE
PLUS
EXTRA
SUPER

Landline Phone No: *
To Connect To
Location: *
Address
BY SIGNING BELOW, THE CUSTOMER AGREES AS FOLLOWS:
1. Vodafone will provide you with the Services.
2. Our supply of Services to you is governed by the Agreement. “Agreement” means this form signed by you, our Broadband Terms, any applicable Broadband Plan, Special terms and any Email Instructions you give.
3. Our Broadband Terms may change from time to time without prior notice to you. For the most up to date version, please visit our website http://www.vodafone.co.ck.
4. Vodafone may accept Instructions delivered by email, over the phone, or in person at any one of our outlets. Access to the email address for email Instructions provided above is strictly limited to you and/or your Authorised Contact Person. You acknowledge this person has authority to act on your behalf, including to make changes to the Services. You will be bound by any such changes.
5. You will promptly notify us of any change in your information provided above.
CUSTOMER DECLARATION
I, the undersigned, hereby confirm that:
1. I am the Customer or am authorised to enter the Agreement on behalf of the Customer;
2. I have read and understood the Broadband Terms and was given the opportunity to obtain independent legal advice before signing this Customer Agreement Form;
3. Any information provided by or on behalf of the Customer for the purposes of the Agreement, including the information provided above, is true and correct.
Print Name*
Date*

DayMonthYear
Date
Authorized Signature*

Clear
Broadband Terms & Condition
Vodafone Cook Islands Address: P.O. Box 106, Avarua, Rarotonga, Cook hlands I Ph; 682 29680 Email: info@vodafone.co.ck

OFFICE USE ONLY
Staff Name
Signature

Clear
Contract ID
Date Processed

DayMonthYear
Date
Should be Empty:

STATIC IP ADDRESS

BROADBAND PLAN

Broadband Terms & Condition